What is best to improve my under eye area? (Photo)

Question

Hi, Please help me understand how to best approach my under eye area. I've used filler, then dissolved it and then had it redone again... I went for a lower bleph consult a few years go and was told to come back in 5 years. Is it now time? Another provider told me they thought it was more of lymphatic drainage issue causing the puffiness. The rings bother me so much and I don't know what to do. Do I look overfilled? Please help. Thanks so much for any advice.

Thomas A. Mustoe, MD, FACS · Answer

The circles look like fluid and I have seen this problem after fillers on multiple occasions even after they have been dissolved.  I do think it is fluid and represents a reaction to the filler, traces of which can remain for years.  You do not have excess fat so a blepharoplasty would it be helpful.  Sometimes laser can tighten the skin.  Fat grafting ca. help but it is a challenging problem without reliable solutions.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.From the photo I can say that you do not have any extra skin under your eye so I would not recommend you a lower eyelid blepharoplasty. For under eye hallows I can suggest fat injection to under eye area. Also unlike your lower eyelid you have extra saggy skin above your eyes. For a more fresh and elegant look I can recommend upper eyelid blepharoplasty. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. Best Regards!

Nima Shemirani, MD · Answer

Hi @cmc7458. Thank you for sending your photos. There are a few reasons for this swelling. One being that the filler was not placed in the proper tissue plane. Most facial filler products that are injected into this area should ideally be placed in the tissue plane directly on top of the bone, or at least underneath the eyelid muscle layer. If a facial filler product is placed too superficial in the skin, or on top of the muscle layer, the product may settle in with an abnormal appearance and can look to be lumpy, swollen, or irregular. Another reason for the prolonged swelling can be due to the fact that too much facial filler product was used. The filler products that are preferred to treat this area will have some degree of affinity for water molecules so all of these products will exhibit some degree of hydration and swell once injected into the body. Hyaluronic acid facial filler products that were previously injected into an improper tissue plane can be dissolved by hyaluronidase injections. I would recommend an in person consultation. Best of luck, Dr. Nima!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

John Michael Thomassen, MD · Answer

A lower lid blepharoplasty with pinch removal of skin of the lower lid can help efface this ring.  An upper lid bleph would also brighten your eyes and make you look less tired.

Nelson Lee Novick, MD · Answer

From the history and the the photo, there appears to be what has been termed under-eye "puffy pillows," which may result from the prior interventions, such as inappropriate choices of HA fillers for the delicate under eye area and/or placed too superficially within the skin. Unfortunately, the problem, which is believed to lymphedema (lymphatic obstruction) is very difficult to treat, may persist indefinitely, and typically does not respond to dissolving with hyaluronidase.  In patients who have come to me with this condition, I have had gratifying results in treating it using an algorithm of intralesional anti-inflammatory agents. You would wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps, and best of luck

What is best to improve my under eye area? (Photo)

Answers (6)

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